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Global Translational Medicine Mass balance

In the Women’s Health Initiative Observational Study 14. The results of dietary treatments in the
(WHI/OS), the relationship between weight gain and four pre-insulin era are in line with the mass
common diet patterns (a LFD, a reduced-carbohydrate diet, balance approach
a Mediterranean-style diet, and a diet consistent with the
United States Department of Agriculture’s [USDA] Dietary Some critics of the EBT have rightly pointed out that the
[31]
Guidelines for Americans [DGA]) was examined . The results of dietary treatments in the pre-insulin era are
[26]
WHI/OS was a longitudinal study of postmenopausal not in agreement with this century-old paradigm. In those
women aged 49–81 years (n = 93,676) who were enrolled days, type I diabetics were treated with a diet that was very
between 1994 and 1998 and followed for up to 8 years. low in carbohydrate and protein, that is, a diet containing
The conclusion made by the researchers states all that mostly fat . The rationality of this was to minimize the
[31]
is needed: “Our findings therefore challenge prevailing excretion of glucose mass in the urine (glucosuria) so that
dietary recommendations, suggesting instead that a low- the patient would not starve to death. Protein intake was
fat (diet) may promote rather than prevent weight gain also kept at low levels since gluconeogenic amino acids can
after menopause.” The results were the opposite of what raise blood sugar levels.
could have been assumed based on the EBT.
The observations of the pre-insulin era in relation to
12. Extremely obese individuals have very macronutrient distribution and body mass have been
high TEE simulated. Figure 3, which is adapted from Arencibia-
Albite’s and Manninen’s study , shows the results of these
[7]
Based on the EBT, it has been suggested that low TEE is a simulations.
risk factor for obesity , but the evidence does not support
[27]
this assumption. The results from the investigation of 15. A quick look at a recent article that still
Das et al. on the hypothesis stating that both TEE and tries to defend the EBT
resting energy expenditure (REE) are low in extremely [32]
obese individuals showed the opposite, wherein the TEE In their recent paper, Hall et al. attempted to defend
of extremely obese subjects was very high . If the EBT the EBT. They stated, “If we are particularly interested in
[28]
were a valid paradigm, a high TEE should protect against the storage of energy as body fat, then the energy balance
obesity. Similarly, Rimbach et al. have concluded, “TEE is equation E − E = E storage can be specified as E − E = E
in
out
in
fat
out
not a risk factor for, and high TEE is not protective against, + E protein + E carbohydrate ,” where E = energy.
weight or body fat gain over the time intervals tested” . With all due respect, these authors do not understand
[29]
These findings cause more gray hairs for the proponents that energy balance and mass balance are separate balances,
of the EBT. as has already been discussed. The body stores fat as mass,
not as energy, because energy has no mass at all. Moreover,
13. The timing of nutrient mass ingestion changes in both total body mass and fat mass are due to
cannot modify the Law of Conservation of changes in mass balance.
Mass
For the above equation to be valid, the mean absorbed
The timing of nutrient mass ingestion will never be able mass of each macronutrient must be equal to its respective
to modify the Law of Conservation of Mass. The timing mean oxidized mass, which is simply not possible (refer
of nutrient mass ingestion may have an effect on body to 5. Energy balance cannot occur at body mass stability).
mass and fat mass only if it affects mass expenditure.
A well-controlled feeding trial by Ruddick-Collins et al. 16. Diet writers’ favorite hormones
demonstrates this fact in an excellent manner . They 16.1. Leptin
[30]
performed a 4-week crossover isocaloric and eucaloric
feeding trial, comparing “morning loaded” (45%:35%:20% Leptin, a peptide hormone that is predominantly made by
calories at breakfast: lunch:dinner) versus “evening adipose cells, helps to regulate energy balance by inhibiting
[33]
loaded” (20%:35%:45% calories at breakfast: lunch:dinner) hunger . According to the EBT, the macronutrient
calorie intake. This was a free-living study, but all food and distribution of diet should only have a minimal effect on
beverages were provided, making it “the most rigorously leptin levels since it has a minimal effect on body mass
controlled study to assess timing of eating in humans to and fat mass. Hormonal responses have been determined
date” . As can be assumed based on the mass balance in the aforementioned feeding experiment by Kong et al.
[30]
[10]
approach, the results indicated no differences in body mass and their data (Table 1 in Kong et al. ) have shown the
loss, total daily energy expenditure, and resting metabolic complete opposite of what could be assumed based on
rate in relation to the timing of calorie distribution. the EBT, indicating that switching from a “normal diet”

Volume 2 Issue 1 (2023) 9 https://doi.org/10.36922/gtm.222